Hyperbaric medicine is used to treat a variety of health problems and illnesses such as severe anemia, brain injury, burns, carbon monoxide poisoning, and many others. Since the beginning of the Covid-19 pandemic, some institutions have also adopted it as an addition to standard coronavirus treatment in some patients.
This therapy, also called hyperbaric oxygen therapy (HBO), is based on the medical application of the 100% pure oxygen in a pressurized chamber, at pressures two to three times higher than the ambient pressure at sea level.
The oxygen used at these pressures becomes more soluble in blood and penetrates all tissues, eliminating hypoxia (lack of oxygen) more effectively than any other method.
The first to use hyperbaric oxygen (HBO) in patients with Covid-19 were Chinese doctors, who showed a rapid improvement in the restoration of oxygen supply to the entire organism affected by the disease.
In fact, the UHMS (Undersea and Hyperbaric Medical Society), the international governing society in this branch of medicine, has set its eyes on the research they are conducting and recommended and encouraged to realize more work of this style based on the evidence in everyone. .
Preliminary results in one small number of patients they were obtained from some hyperbaric medicine centers in the US and Sweden.
Mariana Cannellotto, president of the Argentine Association of Hyperbaric Medicine and Research (AAMHEI), explains Clarion that there are currently several published scientific studies of treated cases in Europe, the United States and Canada and the results recorded so far suggest that HBO may favorably contribute to the recovery of patients with hypoxemic pneumonia by Covid-19 to avoid, in some cases, transferring the patient to the ventilator and reduce the risk of multi-organ failure caused by hypoxemia and complications, if applied in time.
In Argentina it is used in three hospitals: Santojanni, Muñiz and in the Central de San Isidro.
“Like everything we have so far regarding Covid-19, more studies are needed to confirm it. The significant difference of HBO in relation to other treatments is that indicated as an adjuvant, that is, in conjunction with the specified standard of care. It is a supplement that increases the supply of oxygen to the tissues, decreases cellular oxidative stress, reduces inflammatory interleukins, improves immunity and repairs tissue damage caused by oxygen starvation, ”says Cannellotto.
Sessions are held in pressurized rooms. Photo Shutterstock.
In connection with the accumulated experience of the pandemic, Dr. Nina Subbotina, professor of medicine and author of books on hyperbaric medicine, told Clarín that “it was possible to demonstrate the efficacy of HBO in treating patients with Covid. – 19 reducing the need for intubation and mechanical ventilation in critically ill patients and markedly reducing mortality in severe, severe and moderate cases using a patient scoring system that provides excellent stratification of results and allows comparison with statistically significant international data “.
Born in the former Soviet Union and living in Argentina since 1992, where she arrived to attend a hyperbaric drug conference, Subbotina confirms that hyperbaric oxygen helps treat extreme hypoxia, so characteristic of the new SARS-CoV-2 coronavirus. .
“Oxygen saturation restores to acceptable values from the first HBO sessions and to normal values as treatment progresses. Hyperbaric oxygen prevents the storm of cytokines that characterize this disease, which is responsible for the critical evolution of patients. It makes up for the oxygen debt that builds up quickly and restores the state of the immune system. The anti-inflammatory effect is very important, ”emphasizes Subbotina, who leads the hyperbaric medicine course sponsored by the Argentine Medical Association (AMA).
Sessions in patients with covid last 90 minutes. Photo Shutterstock.
Treatment characteristics
Regarding the dosage form, Cannellotto explains that the patient enters the hyperbaric chamber, where the previous saturation is measured and an oxygen mask with a reservoir is placed, the chamber is closed and the pressurize where the pressure in the chamber gradually increases to the treatment pressure in the protocol (in Argentina this is up to 1.45 ATM).
The treatment time in patients with Covid-19 is 90 minutes. At the end of the session, the depressurization process begins, the patient is removed from the chamber and subsequent saturation is monitored. The number of sessions varies from 5 to 10 on a daily basis.
“The aim of the OHB is to create a greater oxygen solution in plasma. Regardless of its transport through hemoglobin and its better arrival in the tissues, due to the diffusion and penetration of O2 from the plasma into all cells, HBO induces a strong hyperoxia (excess oxygen), ”emphasizes the doctor.
“In patients with hypoxemic pneumonia due to Covid-19, oxygen does not diffuse correctly from the lungs to the red blood cell because of the inflammation that occurs in them. affects oxygen transport, the supply, cellular respiration and energy production by the cell, leading to a cascade of pathophysiological events with deterioration of cellular functions and multi-organ failure. “
“By increasing pulmonary capillary alveolar diffusion, HBO provides greater oxygen dissolution, decreases cellular oxidative stress and inflammation, improves cellular immunity. Fewer days of hypoxia, less damage, more recovery, less consequences. And of course, a lower risk of death.” Cannellotto says.
One of the criteria, Subbotina emphasizes, for starting treatment in a hyperbaric chamber is the decrease in oxygen saturation below 93%, so, he argues, it is better not to waste time starting treatment with HBO.
“I recommend it for patients with low oxygen saturation that determines a likely deterioration in its condition, which can be devastating. The main goal of HBO treatment is to avoid mechanical ventilation, for this it is necessary to start treatment early, when the drop in oxygen saturation is just being observed, ”he concludes.